Solid breast mass characterisation: use of the sonographic BI-RADS classification.

PURPOSE: The aim of this study was to assess the reliability of the sonographic Breast Imaging Reporting and Data System (BI-RADS) classification in differentiating benign from malignant breast masses. MATERIALS AND METHODS: A total of 292 female patients with breast masses undergoing biopsy between November 2004 and March 2006 in our department were included in this study. All lesions were classified according to the sonographic BI-RADS lexicon. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) for the sonographic BI-RADS lexicon and PPV and NPV for each lesion category and each sonographic descriptor were calculated. The chi(2) test and the Fischer exact test were used to evaluate our results. RESULTS: Univariate analysis showed a significant difference between malignant and benign groups with regard to morphology (p<0.001), horizontal-vertical diameter ratio<1 (p<0.002), orientation (p<0.001), noncircumscribed margins (p<0.001), echogenic halo (p<0.001), hypoechoic pattern (p=0.035), shadowing (p<0.001) and surrounding tissue alterations (p=0.001). The cumulative risk for malignancy was 64 and 10 times higher, respectively, in categories 5 and 4 than in category 3. CONCLUSIONS: The sonographic BI-RADS lexicon is an important system for describing and classifying breast lesions.

Angiotensin II increases calponin expression in cultured rat vascular smooth muscle cells.

Angiotensin II (Ang II) action on vascular smooth muscle cells is not limited to contraction, but includes long term effects such as hypertrophy and hyperplasia. This implies a complex pattern of gene modulation, which remains largely unknown. We used the mRNA differential display method to screen rat aortic smooth muscle cells cultured with or without Ang II. We demonstrated that Ang II induces the expression of calponin, a 34-kD protein, which has been shown to regulate smooth muscle cell contraction and to be a marker of smooth muscle cell differentiation. We demonstrated this induction both at gene and protein level in vascular smooth muscle cells. Calponin mRNA was dose-dependently induced by Ang II, with an effect still evident at 5 x 10(-9)M, and it did not require active protein synthesis, since cycloheximide treatment did not suppress this induction. Calponin gene expression was maximal at 3 h, while protein expression was maximal at 8 h. Calponin expression was completely abolished by the AT1 receptor antagonist, losartan, at 1 x 10(-6)M. Our data demonstrate that Ang II increases calponin gene expression and protein level in rat aortic smooth muscle cells in vitro.

Echocardiographic imaging in coronary artery disease: new techniques.

When analyzing left ventricular wall motion and thickening, two-dimensional echocardiography (2DE) represents a useful non-invasive tool for diagnosing and stratifying ischemic heart disease. New important technical advancements, such as harmonic imaging, allow to overcome limitations due to poor echocardiographic image quality in a large proportion of patients. Combination of exercise or pharmacological stress test with on-line echo images monitoring expands 2DE diagnostic and prognostic value in both ischemia or viability assessment. Study of contrast agents distribution is very promising for clarifying the complex interaction between myocardial perfusion and functional correlates, including myocardial stunning, hibernation and no-reflow phenomena. Direct visualization of epicardial coronary arteries and assessment of coronary artery blood flow has recently been demonstrated to be possible by either transthoracic (TTE) or transesophageal echocardiography (TEE). Acoustic quantification (AQ), automatic border detection (ABD), tissue Doppler imaging (TDI), and color kinesis are other technical modalities which may result to be useful for clinical evaluation of patients with either acute or chronic coronary syndromes.

The ranking of Italy's publications in the biomedical field: an objective evaluation.

To evaluate the scientific output of Italy compared to other countries in clinical and basic research, the twelve top ranking journals according to the impact factor in each group were considered. A total impact factor score of one country was the sum of the impact factor of all articles attributed to a certain country in all journals. Italy ranked sixth in clinical research but only ninth in basic research. According to our analysis, the Italian scientific output in the biomedical field is comparable to that of other countries. Further financial analysis of the correlation between research funding and scientific output could allow a more productive allocation of resources.

Prognostic role of heart rate variability in patients with a recent acute myocardial infarction.

A low heart rate variability (HRV) has been shown to be a powerful predictor of cardiac events in patients surviving an acute myocardial infarction (MI), but it is not clear yet which among the HRV parameters has the best predictive value. Time domain and frequency domain HRV was assessed on 24-hour predischarge Holter recording of 239 patients with a recent MI. Patients were followed up for 6 to 54 months (median 28), during which 26 deaths (11%) occurred, 19 of which were cardiac in origin and 12 were sudden. Most HRVs did not show any difference between patients with or without mortality end points, but the average low-frequency and low-frequency/high-frequency ratio was lower in patients with events. However, when dichotomized according to cut points that maximized the risk of sudden death, several HRVs were significantly predictive of clinical end points. Overall, the mean of the standard deviations of all RR intervals for all 5-minute segments and the standard deviation of the mean RR intervals for all 5-minute segments were the time domain variables most significantly associated with mortality end points, whereas very low frequency was the most predictive frequency domain variable. Compared with the best time domain variables, very low frequency showed a better sensitivity (0.27 to 0.42 vs 0.19 to 0.33) for end points with only a small loss in specificity (0.92 vs 0.96). On multivariate Cox proportional analysis, a left ventricular ejection fraction <40% and a number of ventricular premature beats > or = 10/hour were the most powerful independent predictors for all end points, whereas no HRV was independently associated with the events. A low frequency/high frequency ratio < 1.05 only had a borderline association with sudden death (RR = 2.86, p = 0.076). Our data show a strong association between HRV and mortality in patients surviving a recent MI, with a slight better sensitivity of frequency domain analysis. In our study, however, HRV did not add independent prognostic information to more classic prognostic variables (e.g., left ventricular function and ventricular arrhythmias).